Comparative Outcomes of Lower Extremity Fractures in Patients With Type 1 and Type 2 Diabetes: A Retrospective
Thomas E Olson1, Christopher Hamad1, Joshua Wiener2
1Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California.
Orthopedics
|July 7, 2026
Summary
Type 1 diabetes mellitus (T1DM) patients face significantly higher risks of infection, amputation, and mortality after lower extremity fracture surgery compared to Type 2 diabetes mellitus (T2DM) patients. This underscores the need for tailored perioperative care based on diabetes type.
Area of Science:
- Orthopedic Surgery
- Endocrinology
- Trauma Care
Background:
- Diabetes mellitus (DM) is a known risk factor for poor outcomes in orthopedic trauma.
- The comparative impact of type 1 diabetes mellitus (T1DM) versus type 2 diabetes mellitus (T2DM) on lower extremity fracture fixation complications is not well understood.
Purpose of the Study:
- To compare postoperative outcomes between T1DM and T2DM patients undergoing surgical fixation of lower extremity fractures.
- To identify specific complication risks associated with each diabetes subtype in this patient population.
Main Methods:
- Retrospective cohort analysis of 10,464 patient-fracture encounters.
- Propensity score matching within anatomical fracture subgroups to control for baseline characteristics.
- Comparison of adverse outcomes including infection, amputation, and mortality using statistical and survival analyses.
Main Results:
- T1DM patients exhibited significantly higher rates of infection, amputation, and mortality compared to T2DM patients post-fracture fixation.
- Complication rates, particularly for infection and amputation, were highest in distal fractures (tibia, foot/ankle) for T1DM patients.
- Mortality rates were substantially elevated in T1DM patients across all analyzed lower extremity fracture sites.
Conclusions:
- T1DM confers a substantially higher risk of severe adverse outcomes, including infection, limb loss, and mortality, following lower extremity fracture fixation compared to T2DM.
- These findings emphasize the critical need for diabetes-subtype-specific perioperative management strategies to mitigate risks in orthopedic trauma patients with DM.
Related Concept Videos
01:26Type I Diabetes II: Pathophysiology
Type 1 diabetes mellitus arises from an immune-mediated destruction of pancreatic β-cells, resulting in an absolute deficiency of insulin. This process develops in genetically susceptible individuals when autoimmunity, environmental exposures, and immunologic dysregulation converge to trigger a targeted attack on the insulin-producing cells of the pancreas. The β-cells are located within the islets of Langerhans and are essential for regulating blood glucose by facilitating cellular uptake of...
01:24Type II Diabetes II: Pathophysiology
PathophysiologyType 2 diabetes mellitus (T2DM ) is a chronic metabolic disorder characterized by insulin resistance and progressive pancreatic β-cell dysfunction, leading to impaired glucose homeostasis. It results from interactions among genetic predisposition, environmental factors, and metabolic stressors, such as overnutrition and a sedentary lifestyle.Insulin Resistance and Glucose DysregulationEarly T2DM involves insulin resistance in skeletal muscle, adipose tissue, and the liver.
01:22Diabetes Mellitus: Overview and Type I Subtype
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
01:22Diabetes Mellitus: Type 2 and Gestational
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
01:19Type I Diabetes III: Clinical Manifestations
Type 1 diabetes mellitus typically presents with rapid-onset symptoms due to the body’s inability to utilize glucose in the absence of insulin. Since insulin is required for glucose uptake into cells, its deficiency leads to hyperglycemia and cellular energy deprivation, resulting in characteristic clinical features.Polyuria and PolydipsiaOne of the earliest, most prominent symptoms is polyuria (excessive urination). When blood glucose concentrations rise above the renal threshold, the kidneys...
01:31Diabetic Foot Ulcer
Definition A diabetic foot ulcer (DFU) is a chronic, non-healing wound that develops in individuals with diabetes. It typically occurs on pressure-bearing areas such as the heel, metatarsal heads, or hallux, and carries a high risk of infection and amputation.Pathophysiology • The development of DFUs can be explained by four interconnected mechanisms: neuropathy, ischemia, infection, and impaired wound healing. • Neuropathy is the most common factor. Sensory neuropathy reduces pain perception,...